Neoadjuvant and Adjuvant Therapies for High-Risk Prostate Cancer

High-risk localized prostate cancer (HR-PCa) presents a substantial risk of recurrence and progression despite definitive local treatment. This article evaluates the evolving role of neoadjuvant and adjuvant therapies, including androgen deprivation therapy, second-generation androgen receptor pathway inhibitors, and chemotherapy. While neoadjuvant strategies improve pathologic responses, survival benefits remain unproven. Adjuvant therapy is increasingly individualized, with early salvage radiotherapy favored over routine adjuvant radiotherapy based on recent trial data. Ongoing studies, molecular profiling, and advanced imaging aim to refine patient selection and personalize treatment, balancing oncologic control with quality of life in the management of HR-PCa.